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UHS fought with Bexar County Jail about over-crowding, suicide risk

University Health System staff worried about the impact of jail over-crowding at Bexar County Jail and fought to change jail practices like housing suicidal inmates in parts of the jail not intended for suicidal observation, recently released emails show.

“There is a lot of confusion regarding housing for suicidal inmates,” Lydia Mesquiti wrote to staff members on March 13, 2009. “The jail administrator is allowing suicidal inmates to be housed in PODs that are not designated as a Suicide Prevention Unit. Our Department (UHS-DHCS) policy has NOT changed. When we find someone with a suicide potential and place him on suicide precautions he is to got the SPU or OB (if female) or MT-O1.”

Mesquiti, the director of mental health services over UHS' jail contract with Bexar County, instructed her staff to continue correctly classify every suicidal inmate even if they weren't being housed in under the right conditions.

“We are not authorizing any suicidal inmates to any other units,” she wrote. “If a suicidal inmate is taken to another unit not designated for suicide prevention then you are to call the UHS Vice President Theresa Scepanski.”

Jail Administrator Roger Dovalina told the Current last month that overcrowding likely contributed to the high number of suicides at the jail that ended up tripling the national average. A review of jail records showed cases where the inability to house inmates in the suicide unit because of overcrowding appeared to contribute to hanging deaths.

Later, UHS staff began lobbying hard for changes in housing these at-risk detainees that Chief Dovalina apparently was not willing to make. (Calls to Dovalina were not immediately returned Thursday.)

On March 14, UHS VP Teresa Scepanski wrote staff after hearing that jail personnel were placing suicidal inmates in the required smocks but not in the suicide prevention unit. “I spoke to Shift Commander `Capt. David Salinas` and explained this “new” policy cannot go into effect until we can meet and discuss a process that does not conflict with the regulations. â?¦ I requested this inmate be placed in MT01. Shift Commander did not cooperate with my request,” Scepanski wrote.

UHS mental-health employees had been lobbying to turn an open area of the jail (MT01) into a makeshift suicide watch area, a suggestion that was ultimately rebuffed.

However, a month later, a little progress was made when Dovalina instructed jail staff to up their observation rounds from every 30 minutes to every 15 minutes wherever suicidal inmates were being housed.

After 412 suicide attempts (see chart, right) and three hanging deaths, a sheriff's deputy wrote in August of a “circle of frustration” existing in the booking area over continued failures to get suicidal inmates properly housed and treated.

“The mental health staff blame the medical staff, who in turn blame classification, then the blame is back on mental health staff. It is a circle of frustration and during this time the inmate creates problems for the booking staff," the Bexar County deputy wrote. "I am under the impression that an inmate evaluated and found to be suicidal, should at least be monitored or at least check on occasion by mental health unit, that hardly happens.”

Instead, suicidal detainees were being forced to sit on a stool in front of the sergeant's desk until a cell was located for them. This process could take up to 48 hours, the deputy wrote.

On December 4, Chief Dovalina issued Administrative Directive 09-30 ordering staff to conduct 30-minute surveillance of inmates housed in Intake (including detox where at least one suicide occurred last year) or the jail annex. They had been making the rounds every hour.

According to the department's Suicide Prevention Log, 769 inmates attempted to take their lives at the jail in 2009. As reported in Hang Time, Bexar County Sheriff Amadeo Ortiz invited a national expert in suicide prevention to come examine the jail and its operations after the 6 suicides of '09. More than 50 pages of UHS emails released to the Current show a health department grappling with a problem far beyond their power to control.